This is the third in a four-part series examining prescription drug abuse in West Virginia. For more stories in this series, click here.
WILLIAMSON, W.Va. -- It's early morning and the streets are empty. All you can hear is the train that cuts through town.
A few years ago, crowds of people filled the lot outside a clinic on Third Avenue. When they got inside, they paid cash to get prescriptions for painkillers and other drugs, investigators allege.
A couple of blocks away, people lined up before 6 a.m. to visit another clinic's doctor.
The community was frustrated.
"They called it Pilliamson, instead of Williamson," said Mingo County Prosecuting Attorney Michael Sparks. "It was an open secret, you might say."
Federal and state authorities are handling an ongoing investigation of the clinics, but Sparks says prescription drug abuse causes most of the local crimes he prosecutes -- robberies, assaults, forgery.
Even though the clinics are now shuttered, substance abuse still plagues the area.
People can still find pills. They can't find treatment for their addiction. A local pastor sees drugs destroy families and kill young people.
"Thankfully, that blight's not there anymore," Sparks said on a recent afternoon, pointing to the nearly empty parking lot that was once filled with drug seekers. "But it's a battle that's far from over."
'Like herding cattle'
People traveled long distances to the Mountain Medical Care Center, formerly known as the Williamson Wellness Center. They paid $450 for the first visit, according to federal court papers.
They had to visit monthly to get their prescriptions renewed -- for $150 -- and usually didn't see a doctor, investigators allege. Instead, a receptionist asked whether their complaint was the same as before.
Most patients allegedly got prescriptions for painkillers and anti-anxiety pills they abused or sold. The clinic called in the prescriptions to local pharmacies.
Court papers say Mountain Medical, which closed last year, wrote prescriptions for more than 44,000 people. Sometimes the clinic saw 400 patients a day.
Williamson's population is about 3,000.
One patient described the clinic's practices "as like herding cattle through a process," investigators wrote in court papers.
A few blocks away, outside a now-shuttered house, patients also lined up to visit a smaller clinic operated Dr. Diane Shafer. Court filings allege she accepted cash to write questionable prescriptions. Last year, one of her employees pleaded guilty to giving out prescriptions pre-signed by Shafer in exchange for some of the pills.
In court filings, investigators say that in 2009, Mountain Medical took in more than $4.6 million in cash. They believe Shafer netted more than $1.36 million a year.
Williamson's city budget lost a significant chunk of tax revenue when the clinics closed, Mayor Darrin McCormick said.
Police and prosecutors say it's tougher to investigate prescription drug crimes than those involving illegal substances like cocaine and heroin.
"It's not as black and white," said Sgt. Mike LaFauci of the State Police's drug diversion unit. "If you have crack cocaine in your pocket, you know it's illegal. If you have a Lortab in there, that's a gray area."
It is difficult for police to prove that a doctor is feeding someone's addiction, rather than treating real pain, LaFauci said.
"Pain management is subjective. All that doctors are really required to hear is, 'I have a pain,'" LaFauci said. "When you get into the standard of care, it's a tricky thing for us to prove."
Investigations take years, he said. Patient records are hard to obtain, and once they get them, medical experts must pore over the documents.
Many pill-mill doctors try to escape scrutiny by refusing to take insurance or Medicaid, said Steven Loew, assistant U.S. Attorney. Some require patients to bring X-rays or MRIs, thinking that will thwart prosecution.
"They increase the amount of records that they keep," he said. "They will adapt with their tools, and do everything that they can to fly under the radar screen."
U.S. Attorney Booth Goodwin says prescription drug abuse is one of his office's top concerns. He is focusing on "getting the money" -- seizing assets netted from illegal activity.
"Sometimes, people are willing to do the jail time just as long as you don't take the money," he said.
In Williamson, federal prosecutors have seized assets from Shafer, and from Mountain Medical Care Center's Dr. Katherine Hoover, as well as the clinic's office manager.
Between 2002 and 2010, Hoover was the state's No. 1 prescriber of controlled substances.
None of the doctors who worked at the clinics has been charged with any crime.
Hoover now lives in Nassau, the capital of the Bahamas. She says she went there last year because of health problems and because she feared for her safety.